Policymakers were challenged this year to find an answer to voters’ demands for affordable healthcare coverage options. Both leading legislative proposals, a public health insurance option and restoring previous cuts to HUSKY parent coverage, had drawbacks and neither passed.
The administration, together with the insurance industry, developed an alternative behind closed doors that did pass. That alternative, Covered Connecticut, has advantages over the other two, but raises different concerns. Covered Connecticut was designed to both “mirror” Massachusetts’ similar program but also as a “look-alike” to HUSKY.
While the program has the potential to fill an important gap for thousands of state residents, the administration will have to engage stakeholders left out of the process to ensure its success and survival.
Covered Connecticut is a zero-cost health insurance option for low-income adults who aren’t eligible for HUSKY. Members can sign up for one of two silver-level plans offered on Access Health CT, Connecticut’s health insurance exchange, from Anthem or ConnectiCare. Any premiums or copays, above federal subsidies, are covered by the state. Dental and non-emergency transportation services that aren’t covered by the health plans, will be provided through HUSKY. Covered Connecticut began enrolling eligible parents and caretakers of HUSKY children this July. Other adults can apply beginning in July 2022. People can apply for Covered Connecticut through Access Health CT.
To fund Covered Connecticut, the state is leveraging very generous federal health insurance subsidies, some of which are temporary, and a potential federal waiver to allow certain coverages to run through Medicaid. The remaining costs will be covered by the state budget. Originally, a more ambitious plan of premium subsidies was to be funded by increasing taxes on health insurance premiums, which would have increased premiums for some in order to provide subsidies to others. The tax increase was strongly opposed by the insurance industry and did not pass.
Covered Connecticut is expected to cover 31,000 people, more than the original proposals at a lower cost for the state. Many of the new, lower income Covered Connecticut members are likely now uninsured. Reversing previous cuts to HUSKY parents would’ve covered about half that number but most are likely uninsured now. Covered Connecticut, even with the HUSKY wraparound for dental and transportation, doesn’t include all HUSKY services, but it comes close.
It is unclear how many people would’ve been covered by the proposed public option, but it is likely far fewer than Covered Connecticut. The public option, based on the state employee plan, would probably have been an expensive option. It may have lowered premiums for some small businesses, but it was unlikely to have covered many uninsured state residents. Transparency in the state’s current public option for municipalities is weak, so we may never have known how many it covered, how much it cost, or if it worked for members.
To ensure that Covered Connecticut is successful, the CT Health Policy Project collected advice from stakeholders in other states with similar premium assistance programs, including Massachusetts, and feedback from Connecticut stakeholders.
Other states have struggled with “churn,” the term for members with fluctuating incomes bouncing between HUSKY and Access Health CT plans like Covered Connecticut. Plans available to low-income applicants in Connecticut and other states often have narrow networks of providers, making it hard to find care when it’s needed. Connecticut’s HUSKY plan has developed a robust panel of participating providers. Insurance plans also have closed formularies that restrict access to some medications that may be expensive but are medically necessary. Coordinating services between programs can be a challenge.
Connecticut stakeholders were generally positive about Covered Connecticut but shared some concerns. It is critical that applicants are fully informed that, unlike HUSKY, if their income increases during the year, they may have to pay back some of the premium subsidies at tax time. There are serious privacy concerns with Covered Connecticut. Unlike HUSKY, private plans and their vendors often capture and sell personal information. Access to HUSKY’s successful Intensive Care Management for Covered Connecticut members could improve outcomes for members at-risk for costly health problems.
Finally, advocates are concerned that Covered Connecticut is a first step toward returning HUSKY to managed care organizations. This would be a grave mistake. Connecticut has saved billions of tax dollars, provider participation is substantially better, and quality has improved since we moved HUSKY out of private, managed care plans and into care management in 2012. Other states are just now learning that lesson.
Covered Connecticut is a good program that came out of sincere efforts to cover the uninsured and maximize federal subsidies. As with all good ideas, they need to be monitored over time to be sure they work. The legislative oversight included in state law will help with that. All commenters stressed that if Congress doesn’t make the premium subsidies permanent, or the state budget returns to a deficit, Covered Connecticut could end. It is critical for the administration to engage stakeholders left out of the process to overcome the challenges as they arise.
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